Celiac Disease and Gluten Sensitivity: What Are the Differences

It sounds like celiac disease and it feels like celiac disease – but it’s not. Physicians are now being advised to consider symptoms such as stomach bloat, fatigue and muscle and joint pain when diagnosing non-celiac gluten sensitivity, a relatively new condition on the spectrum of gluten-related disorders.

“There is tremendous confusion when it comes to these disorders,” explains Dr. Alessio Fasano, the head of the Celiac Disease Center at the University of Maryland and one of the authors of a new guide on how to define them, published in the journal BMC Medicine.

Like wheat allergy and celiac disease, gluten sensitivity occurs in reaction to a protein found in wheat, barley and rye. Unlike celiac disease, the reaction is not an autoimmune response, in which one’s immune system sees gluten protein as intruder and will initiate a protective response that damages the small intestine.

Nor does it lead to the development of osteoporosis, neurological issues or other autoimmune diseases – as celiac disease can. But gluten sensitivity can still be horribly uncomfortable and painful. It’s a condition that Fasano says is related to “the older, innate” immune system that is not as sophisticated, modern as the adaptive immune system, which is the one linked to the other conditions on the spectrum.

To add to the confusion, symptoms of gluten sensitivity may start and stop without warning.

The new recognition of this condition should lead to speedier diagnoses for patients who complain of symptoms but test negative for celiac disease and wheat allergy. It also helps to explain why such patients who eliminate gluten from their diets despite the negative test findings do feel better.

“We’re at the same place with gluten sensitivity that we were almost 20 years ago with celiac disease,” Fasano says. “We’re just beginning to understand how it affects certain individuals.”